Consumers are willing to pay more for broader provider networks and many, including women, also place high priority on maintaining coverage for providers to whom they are already connected when...
As payers lean more heavily on remote care, consumers stressed the need for greater convenience in care delivery and prefer to turn to telehealth and digital solutions, in part, as the answer,...
Seriously ill populations tend to enroll in health plans that are less restrictive and that boast broader networks, a recent American Journal of Accountable Care (AJAC) study found.
The AJAC study...
The medical loss ratio is a financial standard that plans on the Affordable Care Act exchanges must uphold. It sets the baseline for how much of payer revenue must go directly toward covering consumer...
Updated 7/7/2020: This article has been updated to reflect that CitiusTech is solely responsible for the “COVID-19 Impact on Quality Management” survey. A previous version associated...
Payers are finding new ways to tackle social determinants of health as new challenges emerge, America’s Health Insurance Plans (AHIP) explained.
Much of the common knowledge that payers have...
Blue Cross and Blue Shield of North Carolina (Blue Cross NC) will financially support local independent primary care practices as they transition to value-based care during the coronavirus pandemic,...
The Centers for Disease Control and Prevention (CDC) estimates that 90 percent of national healthcare spending goes toward chronic disease management and mental healthcare, which means that strong...
CMS has proposed a rule that allows payers to adopt new value-based payment models for gene therapies.
“CMS’s rules for ensuring that Medicaid receives the lowest price available for...
Value-based insurance designs that incorporate zero copay programs for certain drugs may help decrease total chronic disease spending—including member and payer costs—when the designs focus...
The debate over the usefulness of prior authorizations for value-based contracting is often torn between providers who find the administrative elements burdensome and payers who find the programs...
At Community Health Plan of Washington, population health management tools allow the organization to integrate social determinants of health data across its network of community health...
In the face of coronavirus, payers have a unique opportunity to show their support for provider networks in a tangible way.
For more coronavirus updates, visit our resource page, updated twice daily...
Success in value-based care requires collaboration between payers and providers. They must work together to negotiate the terms of the contract, including outlining the quality metrics and incentives...
A bundled payment model born from a payer-provider partnership between Blue Cross Blue Shield Rhode Island (BCBSRI) and University Orthopedics has helped deliver a holistic, outpatient delivery of a...
The healthcare industry is moving away from fee-for-service reimbursement. Healthcare professionals recognize that this payment structure is fraught with misuse and overuse, incentivizing providers to...
Payers have not forgotten about the social determinants of health that can be exacerbated by a pandemic and have continued to commit investments to these causes.
This comes in addition to actions such...
As several states look to launch a state-based health insurance marketplace (SBM), experts warn that policymakers should weigh the decision carefully and pursue a marketplace only as part of a...
The number of commercially insured Americans age 30 to 64 diagnosed with early-onset dementia or Alzheimer’s disease increased by 200 percent from 2013 to 2017, according to an assessment of...
The U.S. Preventive Services Task Force (USPSTF) has made a B-level recommendation that all young adults and adolescents should be screened for hepatitis C, which has become more prevalent in the wake...
